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Observational study of newborn infant parasympathetic evaluation as a comfort system in awake patients admitted to a pediatric intensive care unit

  • Juan Valencia-RamosEmail author
  • Juan Arnaez
  • Sara Calvo
  • Fernando Gomez
  • Isabel Del Blanco
Original Research
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Abstract

To compare the newborn infant parasympathetic evaluation system (NIPE) scores with a validated clinical scale using two different nebulizers in children with bronchiolitis admitted to a PICU. Comfort was evaluated using the COMFORT-behavior scale (CBS) before (T1), during (T2) and after (T3) each nebulization. In order to compare NIPE and CBS values during the whole T1 to T3 period, the variable Dif-CBS was defined as the difference between maximal and minimal CBS scores, and Dif-NIPE as the difference between 75th and 25th percentile NIPE values. Analyses were carried out, firstly for the total of nebulizations and secondly comparing two different nebulization systems: a jet nebulizer (JN) and a nebulizer integrated in high flow nasal cannulas (NHF). 84 nebulizations were recorded on 14 patients with a median [25th–75th percentile] age of 6 months (3.1–9.5). A Dif-CBS of 4 points (2–7), as well as changes in CBS scores between T1 and T2, defined the nebulization as a discomfort stimulus. The NIPE system, represented as the Dif-NIPE, showed a median variation of 9 points (7–10), and was poorly correlated to Dif-CBS [rs 0.162 (P = 0.142)]. Discomfort during nebulization, assessed by CBS was greater with the JN system compared to NHF: 17 (13–22) vs 13 (9–15) (P = 0.001). NIPE monitoring detected no significant differences between both nebulization systems (P = 0.706). NIPE monitoring showed a variation in comfort during nebulization in the patient with bronchiolitis, though correlation with CBS was poor. Further research is required before NIPE can be suggested as a comfort monitoring system for the awake infant.

Keywords

Comfort Newborn infant parasympathetic evaluation COMFORT Behavior Scale Nebulization Bronchiolitis 

Notes

Acknowledgements

We are grateful to MMDOLORIS for providing a NIPE monitor for this study.

Compliance with ethical standards

Conflict of interest

No conflicts of interest declared.

References

  1. 1.
    Viswanathan M, King VJ, Bordley C, Honeycutt AA, Wittenborn J, Jackman AM, Sutton SF, Lohr KN. Management of bronchiolitis in infants and children. Evid Rep Technol Assess (Summ). 2003;69:1–5.Google Scholar
  2. 2.
    American Academy of Pediatrics, Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774–93.CrossRefGoogle Scholar
  3. 3.
    Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62–72.CrossRefGoogle Scholar
  4. 4.
    Deshpande SA, Northern V. The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area. Arch Dis Child. 2003;88(12):1065–9.CrossRefGoogle Scholar
  5. 5.
    Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S, American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474–502.CrossRefGoogle Scholar
  6. 6.
    Atigapramoj NS. Bronchiolitis: what’s all the fuss about? J Emerg Med. 2018;54(1):127–8.CrossRefGoogle Scholar
  7. 7.
    Walsh P, Rothenberg S. American Academy of Pediatrics 2014 bronchiolitis guidelines: bonfire of the evidence. West J Emerg Med. 2015;16(1):85–8.CrossRefGoogle Scholar
  8. 8.
    Castro-Rodriguez JA, Rodriguez-Martinez CE, Sossa-Briceño MP. Principal findings of systematic reviews for the management of acute bronchiolitis in children. Paediatr Respir Rev. 2015 Sep;16(4):267–75.Google Scholar
  9. 9.
    Carsin A, Sauvaget E, Bresson V, Retornaz K, Cabrera M, Jouve E, Truillet R, Bosdure E, Dubus JC. Early halt of a randomized controlled study with 3% hypertonic saline in acute bronchiolitis. Respiration. 2017;94(3):251–7.CrossRefGoogle Scholar
  10. 10.
    Harris J, Ramelet AS, van Dijk M, Pokorna P, Wielenga J, Tume L, Tibboel D, Ista E. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016;42(6):972–86.CrossRefGoogle Scholar
  11. 11.
    Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Lauer A, Munro H, Farley F. Pain management in children with and without cognitive impairment following spine fusion surgery. Paediatr Anaesth. 2001;11(4):453–8.CrossRefGoogle Scholar
  12. 12.
    Brand K, Thorpe B. Pain assessment in children. Anaesth Intensive Care Med. 2016;17:270–3.CrossRefGoogle Scholar
  13. 13.
    Morton NS. Pain assessment in children. Paediatr Anaesth. 1997;7(4):267–72.CrossRefGoogle Scholar
  14. 14.
    Ledowski T, Tiong WS, Lee C, Wong B, Fiori T, Parker N. Analgesia nociception index: evaluation as a new parameter for acute postoperative pain. Br J Anaesth. 2013;111(4):627–9.CrossRefGoogle Scholar
  15. 15.
    Jeanne M, Logier R, De Jonckheere J, Tavernier B. Heart rate variability during total intravenous anesthesia: effects of nociception and analgesia. Auton Neurosci Basic Clin. 2009;147(1–2):91–6.CrossRefGoogle Scholar
  16. 16.
    Jeanne M, Logier R, De Jonckheere J, Tavernier B. Validation of a graphic measurement of heart rate variability to assess analgesia/nociception balance during general anesthesia. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:1840–3.Google Scholar
  17. 17.
    Migeon A, Desgranges FP, Chassard D, Blaise BJ, De Queiroz M, Stewart A, Cejka JC, Combet S, Rhondali O. Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Paediatr Anaesth. 2013;23(12):1160–5.Google Scholar
  18. 18.
    Avez-Couturier J, De Jonckheere J, Jeanne M, Vallée L, Cuisset J-M, Logier R. Assessment of procedural pain in children using analgesia nociception index: a pilot study. Clin J Pain. 2016;32(12):1100–4.CrossRefGoogle Scholar
  19. 19.
    Carnavale FA, Razack S. An item analysis of the COMFORT scale in a pediatric intensive care unit. Pediatr Crit Care Med. 2002;3(2):177–80. 4p.CrossRefGoogle Scholar
  20. 20.
    Valencia-Ramos J, Mirás A, Cilla A, Ochoa C, Arnaez J. Incorporating a nebulizer system into high flow nasal cannula improves comfort in infants with bronchiolitis. Respir Care. 2018;63:886–93.CrossRefGoogle Scholar
  21. 21.
    McGrath PJ, Frager G. Psychological barriers to optimal pain management in infants and children. Clin J Pain. 1996;12(2):135–41.CrossRefGoogle Scholar
  22. 22.
    Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr. 2018;177(6):913–20.CrossRefGoogle Scholar
  23. 23.
    Kou M, Hwang V, Ramkellawan N. Bronchiolitis. From practice guideline to clinical practice emerg. Med Clin North Am. 2018;36(2):275–86.CrossRefGoogle Scholar
  24. 24.
    Van Dijk M, De Boer JB, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ. T The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain. 2000;84(2–3):367–77.CrossRefGoogle Scholar
  25. 25.
    Bosch-Alcaraz A, Falcó-Pegueroles A, Jordan I. A literature review of comfort in the paediatric critical care patient. J Clin Nurs. 2018;27:2546–57.CrossRefGoogle Scholar
  26. 26.
    Valkenburg V, Boerlage AJ, Ista AA, Duivenvoorden E, Tibboel HJ, D, Dijk M Van. The COMFORT-Behavior scale is useful to assess pain and distress in 0- to 3-year-old children with Down syndrome. Pain. 2011;152(9):2059–64.CrossRefGoogle Scholar
  27. 27.
    Jeanne J, Clément M, De Jonckheere C, Logier J, Tavernier R. B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput. 2012;26(4):289–94.CrossRefGoogle Scholar
  28. 28.
    Boselli E, Bouvet L, Bégou G, et al. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br J Anaesth. 2014;112(4):715–21.CrossRefGoogle Scholar
  29. 29.
    Boselli E, Logier R, Bouvet L, Allaouchiche B. Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (∆ANI). J Clin Monit Comput. 2016;30(6):977–84.CrossRefGoogle Scholar
  30. 30.
    Le Guen M, Jeanne M, Sievert K, Al Moubarik M, Chazot T, Laloë PA, Dreyfus JF, Fischler M. The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor. Int J Obstet Anesth. 2012;21(2):146–51.CrossRefGoogle Scholar
  31. 31.
    Gall O, Champigneulle B, Schweitzer B, Deram T, Maupain O, Montmayeur Verchere J, Orliaguet G. Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index. Br J Anaesth. 2015;115(6):890–5.CrossRefGoogle Scholar
  32. 32.
    Cremillieux C, Makhlouf A, Pichot V, Trombert B, Patural H. Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index. Eur J Pain. 2018;22:1071–9.CrossRefGoogle Scholar
  33. 33.
    Rakza T, Butruille L, Thirel L, Houfflin-Debarge V, Logier R, Storme L, De Jonckheere J. Short-term impact of assisted deliveries: evaluation based on behavioral pain scoring and heart rate variability. Clin J Pain. 2018;34(5):445–9.Google Scholar
  34. 34.
    van Dijk M, Peters JWB, van Deventer P, Tibboel D. The COMFORT Behavior Scale: a tool for assessing pain and sedation in infants. Am J Nurs. 2005;105(1):33–6.CrossRefGoogle Scholar
  35. 35.
    Szental JA, Webb A, Weeraratne C, Campbell A, Sivakumar H, Leong S. Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI®) monitoring: a randomized clinical trial. Br J Anaesth. 2015;114(4):640–5.CrossRefGoogle Scholar
  36. 36.
    Oberndorfer U, Marhofer P, Bösenberg A, Willschke H, Felfernig M, Weintraud M, Kapral S, Kettner SC. Ultrasonographic guidance for sciatic and femoral nerve blocks in children. Br J Anaesth. 2007;98(6):797–801.CrossRefGoogle Scholar
  37. 37.
    Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P, Association des Anesthésistes Réanimateurs Pédiatriques d’Expression Française (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20(12):1061–9.CrossRefGoogle Scholar
  38. 38.
    Naja Z, Al-Tannir MA, Faysal W, Daoud N, Ziade F, El-Rajab M. A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial. Anaesthesia. 2011;66(9):802–7.CrossRefGoogle Scholar
  39. 39.
    Ledowski T, Averhoff L, Tiong WS, Lee C. Analgesia Nociception Index (ANI) to predict intraoperative haemodynamic changes: results of a pilot investigation. Acta Anaesthesiol Scand. 2014;58(1):74–9.CrossRefGoogle Scholar
  40. 40.
    Lamas A, López-Herce J, Sancho L, Mencía S, Carrillo A, José Santiago M, Martínez V. Responsiveness to stimuli of bispectral index, middle latency auditory evoked potentials and clinical scales in critically ill children. Anaesthesia. 2008;63(12):1296–301.CrossRefGoogle Scholar
  41. 41.
    Cury MRJ, Martinez FE, Carlotti APCP. Pain assessment in neonates and infants in the post-operative period following cardiac surgery. Postgrad Med J. 2013;89(1048):63–7.CrossRefGoogle Scholar
  42. 42.
    Foster RL, Yucha CB, Zuk J, Vojir CP. Physiologic correlates of comfort in healthy children. Pain Manag Nurs. 2003;4(1):23–30.CrossRefGoogle Scholar
  43. 43.
    Carnevale FA, Gaudreault J. The experience of critically ill children: a phenomenological study of discomfort and comfort. Dynamics. 2013;24(1):19–27.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Pediatric Intensive Care UnitBurgos University HospitalBurgosSpain
  2. 2.Department of NeonatologyBurgos University HospitalBurgosSpain
  3. 3.Fundación NeNeMadridSpain
  4. 4.Research UnitBurgos University HospitalBurgosSpain

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